Note: Dr. Laiteerapong and Ms. Cooper had access to the data in the study. Dr. Laiteerapong takes full responsibility for the integrity of the data and the accuracy of the data analysis. The authors completed the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklist ().

Financial Support: Dr. Laiteerapong was supported by grant K23 DK092783 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Dr. Huang is supported by grant K24 DK105340 from the NIDDK. Drs. Laiteerapong and Huang are members of the NIDDK Chicago Center for Diabetes Translation Research at the University of Chicago (P30 DK092949). Dr. Winn was supported by the Royster Society of Fellows at the University of North Carolina at Chapel Hill.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.

Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Readers with questions about the simulation model used in this analysis may contact Dr. Laiteerapong (e-mail, nlaiteer@medicine.bsd.uchicago.edu). The model is not available without written agreement with the authors.

Individualized control saved $13 547 per patient compared with uniform intensive control ($105 307 vs. $118 854), primarily due to lower medication costs ($34 521 vs. $48 763). Individualized control decreased life expectancy (20.63 vs. 20.73 years) due to an increase in complications but produced more QALYs (16.68 vs. 16.58) due to fewer hypoglycemic events and fewer medications.

Results of Sensitivity Analysis:

Individualized control was cost-saving and generated more QALYs compared with uniform intensive control, except in analyses where the disutility associated with receiving diabetes medications was decreased by at least 60%.

Limitation:

The model did not account for effects of early versus later intensive glycemic control.

Conclusion:

Health policies and clinical programs that encourage an individualized approach to glycemic control for U.S. adults with type 2 diabetes reduce costs and increase quality of life compared with uniform intensive control. Additional research is needed to confirm the risks and benefits of this strategy.